Provider Demographics
NPI:1093955262
Name:TONYA CANNON STEWART, OD, PLLC
Entity Type:Organization
Organization Name:TONYA CANNON STEWART, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:CANNON
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-925-2020
Mailing Address - Street 1:45 WEST LAKEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5221
Mailing Address - Country:US
Mailing Address - Phone:601-925-2020
Mailing Address - Fax:601-925-2010
Practice Address - Street 1:45 WEST LAKEVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5221
Practice Address - Country:US
Practice Address - Phone:601-925-2020
Practice Address - Fax:601-925-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS410000282OtherMEDICARE ID-
MS00880126Medicaid
MS410000282OtherMEDICARE ID-
MS512G700489Medicare PIN